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A Review on Usability Features for Designing Electronic Health Records

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Health professionals should record clinical care information in order to provide adequate patient assistance. Such recording process requires an Electronic Health Record (EHR) with complete and integral information adjusted to treatments performed on a patient. Moreover, availability and access to EHR are key features supporting decision making and improve patient care. Nevertheless, designing an EHR fulfilling a set of quality attributes is not an easy task. In fact, an EHR with low usability causes deficient clinical services and poor data quality on medical records. In this paper, an interpretation of the ISO 9241-210 standard, in the context of patients' care in an emergency situation, is presented. It considers three mid-level objectives: understanding, designing and evaluating. In this way, an alignment between high-level guidelines, offered by usability standards, and low-level activities to be followed during an EHR design, is achieved.

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A Review on Usability Features for Designing Electronic Health Records

  1. 1. A Review on Usability Features for Designing Electronic Health Records 1 Luis Bernardo Villa Ivan Cabezas
  2. 2. UNIVERSIDAD DE SAN BUENAVENTURA CALI 2
  3. 3. Content • Introduction • Problem Statement • Usability Standards • EHR Usability • Contribution • Final Remarks 3
  4. 4. Introduction 4
  5. 5. Electronic Health Record  Electronic Health Record – EHR  EHR: Health information of a person, which is created, gathered, managed, and consulted by authorized health care clinicians and staff 5(Massachusetts Medical Society, 2014)(HIPAA, 2014)
  6. 6. EHR Requirements  An EHR should : • Be available • Gather complete and reliable data • Allow a timely access • Bring support to clinicians staff on decision making 6 (Thizy, 2013)(Goldberg et al., 2011)
  7. 7. Problem Statement 7
  8. 8. Problem Statement  The considered problem is two fold: • Users are ignored during the EHR design process, leading to a low usability EHR • There is a lack of clarity regarding how to incorporate users’ requirements in EHR design 8 (Gans, Kralewski, Hammons, & Dowd, 2005)
  9. 9. Research Questions  The addressed problem raises the following research questions: • ¿How to achieve a usable EHR? • ¿How to incorporate users’ requirements within EHR design? 9
  10. 10. Usability Standards 10
  11. 11. ISO 9241-210 Standard 11 (Travis, 2011)(ISO, 2010)
  12. 12. ISO 9241-11 12 (ISO, 1998) (Waloszek, 2010)
  13. 13. NISTIR 7741 13 (National Institute of Standards and Technology NIST, Schumacher, & Lowry, 2010)
  14. 14. ISO/TR 16982 14 (ISO, 2002) Direct involvement of Users Observation of Users Performance-Related Measurements Critical Incidents Analysis Questionnaires Interviews Thinking Aloud Collaborative Design and Evaluation Creativity Methods Indirect Involvement of Users Document-Based Methods Model-Based Methods Expert Evaluation Automated Evaluation Additional Methods and Techniques Log Files Video Capture Scan Converter Electronic Surveys Parallel Design Focus Group Brainstorming
  15. 15. Usability of Electronic Health Records 15
  16. 16. EHR Design 16 EHR Design User- Centered Design Principles of Quality Management Patient Safety Events CRITERIA CONSIDERATIONS Strategy Associated to a development stage when the evaluation is performed. Location Related to where the evaluation is performed. Prejudice Subjectivity or objectivity Inherent to a method which will affect the outcome. Measure of Usability Type of measurement provided by a method (i.e. quantitative or qualitative). Information Granularity of the response provided by a method. Immediateness of Response Speed with which a method generates a response. Intromission Changes in user behavior due to an evaluation scenario. Cost Required resources to perform an analysis and an evaluation. (Armijo, McDonnell, & Werner, 2009)
  17. 17. EHR Usability Evaluation 17
  18. 18. Usability Evaluation Methods 18 (Vadakumacherry, 2011)(ISO, 2002)
  19. 19. EHR Evaluation Usability Protocol 19 (Lowry et al., 2012)
  20. 20. Contribution 20
  21. 21. Proposed Interpretation of the ISO 9241-210 Standard 21
  22. 22. Prioritization of Usability Characteristics 22 Characteristic / Design Component User Centered Design Principles of Quality Management Patients Safety Events Learnability LOW NONE LOW Operability HIGH MEDIUM MEDIUM Protection against user errors HIGH HIGH HIGH Aesthetics of the user interface MEDIUM NONE NONE Intelligibility LOW HIGH HIGH Accessibility MEDIUM NONE LOW  Case of study: EHR focused on patients on an emergency situation
  23. 23. Prioritization according to UCD  HIGH • Operability • Protection against user errors  MEDIUM • Accessibility • Aesthetics of the user interface  LOW • Intelligibility • Learnability 23 User- Centered Design
  24. 24. Prioritization acording to Principles of Quality Management  HIGH • Intelligibility • Protection against user errors  MEDIUM • Operability 24 Principles of Quality Management
  25. 25. Prioritization acording to Patient Safety Events  HIGH • Intelligibility • Protection against user errors  MEDIUM • Operability  LOW • Accessibility • Learnability 25 Patient Safety Events
  26. 26. Final Remarks 26
  27. 27. Final Remarks  The proposed interpretation of the ISO 9241-210 UCD was conceived in the context of patients in an emergency situation  Protection against user errors, intelligibility and operability are among the main characteristics that a usable EHR should fulfill  Proposed interpretation of the standard may be used beyond an EHR design process 27
  28. 28. Final Remarks (ii)  EHR usability is a key factor within an e-Health system  The goals of the proposal and the presented characteristics prioritization, as well, are: • Guide developers to achieve and improve an EHR usable design • Consider principles of quality management and patient safety events • Improve acceptance rates of e-Health systems by physicians • Reduce adverse events caused by human error due to lack of information about patients 28
  29. 29. References • Armijo, D., McDonnell, C., & Werner, K. (2009). Electronic Health Record Usability: Interface Design Considerations. Development. • Gans, D., Kralewski, J., Hammons, T., & Dowd, B. (2005). Medical groups’ adoption of electronic health records and information systems. Health Affairs (Project Hope), 24(5), 1323–33. doi:10.1377/hlthaff.24.5.1323 • Goldberg, L., Lide, B., Lowry, S., Massett, H. A., O’Connell, T., Preece, J., … Shneiderman, B. (2011). Usability and Accessibility in Consumer Health Informatics Current Trends and Future Challenges. American Journal of Preventive Medicine, 40, S187–S197. doi:10.1016/j.amepre.2011.01.009 • HIPAA. (2014). The Definition of Electronic Health Record. Retrieved October 06, 2014, from http://www.hipaa.com/2009/05/the-definition-of- electronic-health-record/ • ISO, I. O. F. S. (1998). ISO 9241-11: 1998: Ergonomic Requirements for Office Work with Visual Display Terminals (VDTs) - Part 11: Guidance on Usability. International Organization for Standardization. Retrieved from http://books.google.com.co/books?id=TzXYZwEACAAJ • ISO, I. O. F. S. (2002). ISO/TR 16982:2002 - Ergonomics of human-system interaction -- Usability methods supporting human-centred design. Retrieved April 24, 2014, from http://www.iso.org/iso/catalogue_detail?csnumber=31176 • ISO, I. O. F. S. (2010). Human-centred design for interactive systems. Ergonomics of human system interaction Part 210 (ISO 9241-210). ISO 9241210. doi:10.1039/c0dt90114h • ISO, I. O. F. S. (2011). ISO/IEC 25010:2011. Software Process: Improvement and Practice (Vol. 2, pp. 1–25). Retrieved from http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=35733 • Lowry, S. Z., Quinn, M. T., Ramaiah, M., Schumacher, R. M., Patterson, E. S., North, R., … Abbott, P. (2012). NISTIR 7804 - Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records. • Massachusetts Medical Society. (2014). EHR Makes Three: Sharing the Exam Room. Retrieved October 06, 2014, from http://www.massmed.org/News-and-Publications/Vital-Signs/EHR-Makes-Three--Sharing-the-Exam-Room/#.VDNYgPl5NqV • National Institute of Standards and Technology NIST, Schumacher, R. M., & Lowry, S. Z. (2010). NISTIR 7741: Guide to the Processes Approach for Improving the Usability of Electronic Health Records. Retrieved from http://www.nist.gov/ • Thizy, D. (2013). EHR Usability for Meaningful Use. Macadamian. Retrieved October 06, 2014, from http://www.macadamian.com/2013/03/26/ehr- usability-meaningful-use/ • Travis, D. (2011). ISO 13407 is dead. Long live ISO 9241-210! Retrieved April 22, 2014, from http://www.userfocus.co.uk/articles/iso-13407-is- dead.html • Vadakumacherry, S. (2011). Concept Map of the Usability Evaluation Methods in HCI. Retrieved October 06, 2014, from http://imsajitha.com/concept-map-and-concept-matrix-of-usability-evaluation-methods-in-hci/ • Waloszek, G. (2010). Design is the Solution – From Visual Clarity to Clarity in the Mind. Retrieved October 06, 2014, from http://www.sapdesignguild.org/editions/edition11/print_clarity.asp 29
  30. 30. Thanks Obrigado Gracias 30
  31. 31. A Review on Usability Features for Designing Electronic Health Records 31 Luis Bernardo Villa Ivan Cabezas
  32. 32. Support Slides 32
  33. 33. Usability  "The extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use."  The effectiveness, efficiency and satisfaction with which specified users achieve specified goals in particular environments. • Effectiveness: the accuracy and completeness with which specified users can achieve specified goals in particular environments • Efficiency: the resources expended in relation to the accuracy and completeness of goals achieved • Satisfaction: the comfort and acceptability of the work system to its users and other people affected by its use 33 (ISO, 1998)
  34. 34. Usability Characteristics • Degree to which the software product allows users to learn its applicationLearnability • Degree to which users find the product easy to use and controlOperability • Degree to which the system protects users from making mistakes Protection against user errors • Extent to which the interface allows an enjoyable and satisfying user interaction Aesthetics of the user interface • Extent to which the software product allows users to recognize whether the software is suitable for your needsIntelligibility • Ease of use and safety for users with specific disabilitiesAccessibility 34 (ISO, 2011)
  35. 35. ISO 9241-210 35 Current Approach Proposed Interpretation

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